Individual
DR. CHERYL RAE BLANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
121 W KAGY BLVD, BOZEMAN, MT 59715-6000
(406) 587-7468
(406) 587-4520
Mailing address
4744 ITANA CIR, BOZEMAN, MT 59715-9330
(406) 579-2427
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
457
MT
103T00000X
Psychologist
Primary
202
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000490807
—
MT
01
—
264349
NEW WEST
MT
01
—
51011
BLUE CROSS - MSU
MT
01
—
52820
BLUE CROSS - PRIVATE PRAC
MT
01
—
86-1155463
TRI CARE
MT
Enumeration date
04/06/2007
Last updated
01/03/2011
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